I really appreciated Tyler Black's video on suicide risk assessment, particularly coming on the heels of a year working in an in-patient setting where suicidality was the main reason patients were admitted. Something he said confirmed a suspicion I had all year: contracting for safety means nothing at all. I think perhaps one out of every twenty safety contracts I saw felt like substantial documents that showed the patient had really gained something in the hospital (these were usually the cases where significant psychoed was needed, and learning has been documented on the safety contract). The hospital I was in admitted far too many people that didn't need to be there, mainly because emergency rooms will send anyone to an in-patient setting. His point that the hospital does nothing at all if the issues are not changeable while in the hospital was congruent with my experience.
A question I had about the Tyler Black video: he said that a low percentage (I think he said something like 15%) of people who died by suicide met the criteria of a psychiatric d/o. I was surprised by this, as I thought that dying by suicide suggests an underlying depressive (or extreme impulsivity). He did say this was more of a philosophical debate, but I wanted to hear Tom's thoughts on this idea.